No abstract

Patients with severe, inoperable cholestasis and intractable pruritus not responding to conventional medical therapy might benefit from a depletion of their bile acid pool by sorbent perfusion since accumulated bile acids are possible responsible for their itching. In vitro, USP-charcoal-coated glass beads removed bile acids from human plasma far better than any other sorbent tested. In order to demonstrate the safety and efficacy and charcoal plasmaperfusion in vivo, five dogs underwent plasmapheresis one week following cholecystectomy and bile duct ligation, and 2.2 +/- 0.2 (mean +/- SD) times their plasma volume was passed over a column containing 400 ml of charcoal-coated glass beads prior to reinfusion. During the procedure the plasma bile acid concentration was reduced by 40.2 +/- 4.0% and the bilirubin level by 48.2 +/- 3.3%. The columns, whose capacity was far from being saturated, retained 1.3 +/- 0.4 times the pre-perfusion plasma pool of bile acids (1.1 +/- 0.2 for bilirubin) suggesting that substantial amounts of bile acids and bilirubin were mobilized from tissue stores. The procedure was well tolerated by the animals and might have promising clinical applications.

Blood centrifugation, with a continuous-flow or semicontinuous-flow system, was used in the treatment of 17 patients with various hematologic disorders. Total plasma exchange (TPE) controlled symptoms of hyperviscosity and arrested bleeding in three patients. In two patients, TPE made is possible to perform urgent surgical procedures. It was a very valuable adjuvant in the treatment of one patient with a Factor VIII inhibitor. Eosinapheresis was not of significant value in the therapy of syndromes associated with eosinophilia. Lymphapheresis significantly reduced peripheral lymphocytosis, aiding in the chemotherapeutic control of chronic lymphosarcoma cell leukemia in one patient. It was of questionable value in the maintenance therapy of two patients with Sézary syndrome. Plateletapheresis significantly reduced peripheral platelet count in thrombocytosis, making it possible to minimize the chemotherapeutic dose and permitting urgent surgical procedures in two patients.

An otherwise healthy elderly man developed massive, life-threatening, sublingual bleeding associated with an idiopathic factor VIII inhibitor. The patient was treated wtih cyclophosphamide, steroids, factor VIII concentrates, and repeated plasmapheresis (including three times with NCI-IBM blood-cell separator). Rapid clinical and laboratory improvement occurred, with complete disappearance of the inhibitor. The patient has remained well, without evidence of an inhibitor, for 8 mo. The possible role of each of the therapeutic measures in the disappearance of the inhibitor and the possible pathogenetic mechanism of this disorder are discussed. A high mortality rate and a striking incidence of sublingual hematoma have been observed in cases in the literature.

An otherwise healthy elderly man developed massive, life-threatening, sublingual bleeding associated with an idiopathic factor VIII inhibitor. The patient was treated wtih cyclophosphamide, steroids, factor VIII concentrates, and repeated plasmapheresis (including three times with NCI-IBM blood-cell separator). Rapid clinical and laboratory improvement occurred, with complete disappearance of the inhibitor. The patient has remained well, without evidence of an inhibitor, for 8 mo. The possible role of each of the therapeutic measures in the disappearance of the inhibitor and the possible pathogenetic mechanism of this disorder are discussed. A high mortality rate and a striking incidence of sublingual hematoma have been observed in cases in the literature.